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Those patients clogging up the ER? They're not all who you may think they are

March 19, 2010 | 5:17
pm

The patients that emergency room docs call "frequent fliers" -- regular visitors to the Emergency Department -- are predominantly white, have insurance and tend to be sicker than most patients who visit the ER less often.

Those findings are among many in a study published this week in the American College of Emergency Physicians' journal, Annals of Emergency Medicine. The study combs through 25 previously published studies that identified the demographic characteristics of patients who visited a hospital's emergency department four or more times in a given year. Such patients represent 4.5% to 8% of all emergency department patients, but account for 21% to 28% of total yearly visits to the ER.

First off, the uninsured represent 15% of frequent ER users (though they account for 16% of American adults). And among all uninsured adults, only 2% use the ER four or more times in a year.

African Americans and women are disproportionately represented in the group with heaviest use of the ER, and patients who are insured by Medicare or Medicaid represent 60% of the ER's frequent fliers. But 60% of those who turn up in an emergency room four or more times in a year are white. And most of the regulars fall into two age groups: patients 25 to 44 years old and those over 65. Frequent ER users were also sicker: They were consistently more likely to be admitted to the hospital during a visit than were less regular patient visitors.

In the decade leading up to 2006, emergency department use rose 36%, leading to crowding that has caused ambulances to have to divert to other hospitals, increasing wait times and boosting the cost of care in the United States. Lawmakers and others have suggested that the steep increase was the result of the uninsured seeking care in emergency rooms and a growing use of the ER by people with non-urgent medical problems.

The authors of the study suggested that efforts, including a recent one in California, to restrict use of the ER by the uninsured and those who are not urgently sick will save little. Bigger savings, the authors suggested, could come from diverting patients with chronic illnesses from frequent ER use.

"The data from these studies challenge the assumption that frequent ED use is a problem of uninsured, ethnic minority patients inappropriately seeking primary care in the ED," concluded the study's authors.